Tendinitis is a painful inflammation or tearing of tendons, tendon-muscle attachments, or tendon sheaths. Commonly affected joints include the shoulder (rotator cuff), hip, heel (Achilles’ tendinitis), and hamstring. The disorder is characterized by restricted joint movement and pain in the joint area. Fluid accumulation causes swelling early in the course of the disorder, but calcium deposits can increase swelling and cause further joint immobility or acute calcific bursitis.
It can be difficult to differentiate tendinitis from bursitis in the initial stages of both conditions. Bursitis is an inflammation of one or more bursae, the padlike sacs that contain synovial fluid; these sacs reduce the friction between tendons, ligaments, and bones. Untreated tendinitis can result in bursitis, which can cause joint immobilization.
Tendinitis may result from a traumatic injury, strenuous exercise, or repetitive movement at a rapid pace. It can also be caused by postural misalignment, defective body development, or complications from another disease process such as any of the rheumatic diseases.
Nursing care plan assessment and physical examination
Ask the patient to describe normal and unusual exercise and activity patterns. Determine if the patient has had localized joint swelling, pain, and restricted movement and which joints have been affected. Ask if the pain has affected sleeping patterns. Establish a history of repetitive joint stress or trauma. Determine if the patient has either a congenital musculoskeletal condition that might have caused the tendinitis or a history of rheumatic disease. Determine if the patient has allergies to specific corticosteroids or local anesthetics, which are sometimes prescribed for tendinitis. The affected joint may be red, warm, and tender to touch. Note to what degree mobility is restricted and the number and location of joints that are involved. Patients may be concerned about permanent long-term immobility or restricted movement and how it will affect their lives. Assess their coping abilities.
Nursing care plan primary nursing diagnosis: Pain (acute or chronic) related to inflammation and swelling of the tendon.
Nursing care plan intervention and treatment plan
First-line therapy is often pharmacologic. Applications of heat, cold, ice, or ultrasound may be indicated to promote relief of pain and inflammation. The physician may also prescribe immobilization using a sling, splint, or cast. Fluid removal by aspiration and physical therapy to prevent “frozen” joints and preserve motion constitute supplementary treatment. In extremely rare situations, surgery may be necessary to loosen calcification.
Focus on symptom relief. Encourage the patient to elevate the affected joint as often as possible to promote venous drainage and decrease the swelling. After the patient has received an intra-articular injection, apply ice for about 4 hours to help control the pain. Teach the patient how to apply ice and heat properly to prevent burning or chilling.
Explain to the patient the need to rest and reduce stress on the affected joints by modifying his or her lifestyle or activities until the condition has improved. If a sling is prescribed, teach the patient how to wear it properly. Instruct the patient to wear a splint during sleep to protect an affected shoulder. When the patient’s joint pain has diminished, assist with range-of-motion and strengthening exercises. To limit the risk of reinjury, encourage the patient to use proper shoes for exercise and to lose weight if needed.
Explain the importance of anti-inflammatory medications, and teach the patient to take them with milk to minimize gastrointestinal (GI) distress. Also caution the patient to report distress, GI upset, nausea, and vomiting. Explain the seriousness of vomiting coffee-ground–like material and the need to seek medical help immediately. Encourage the patient to take medications with food to minimize gastric distress.
Nursing care plan discharge and home health care guidelines
Help the patient find alternatives to repetitive or stressful joint movement. Be sure the patient understands any medications prescribed, including dosage, route, action, and side effects. Caution the patient not to take aspirin with other nonsteroidal anti-inflammatory drugs (NSAIDs). Encourage the patient to use heat or cold therapy as prescribed. Teach the patient to use a barrier between the skin and heat or to use cold therapy to prevent burning or frostbite. Remind the patient to keep follow-up appointments with the physician.
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